I Stand to Protect Doctors and Patients Alike

Dr Vinay Aggarwal, former National President of the Indian Medical Association (IMA) and currently the Chairman of Pushpanjali Medical Centre, is a visionary thinker with an enduring aspiration to reform India’s medical system. His mission involves integrating research and innovation into the healthcare landscape, aiming for transformative changes at the national level and aspiring to extend these efforts globally through collaborations with the World Medical Association.

With exceptional leadership qualities and the resolve to challenge conventional boundaries, Dr Aggarwal has been recognised with numerous prestigious awards, including the esteemed Dr B C Roy Award for his contributions to medical field. He envisions a comprehensive framework where quality, expertise and infrastructure are seamlessly integrated under the aegis of the IMA, positioning Indian healthcare as a global exemplar.

In an exclusive interview with Amresh K Tiwary, Dr Aggarwal candidly reflects on his journey, his landmark initiatives during his tenure at the IMA, and his unyielding commitment to addressing pressing healthcare challenges, such as violence against doctors and ensuring patient safety.

Excerpts from the Interview:
Your journey in healthcare is truly inspiring. Please share with us the pivotal moments that shaped your career.
I come from a humble, middle-class background. After completing my schooling, I had the privilege of being selected for admission to two of India’s premier medical institutions—All India Institute of Medical Sciences (AIIMS) and Maulana Azad Medical College (MAMC). However, due to financial constraints, I chose MAMC to pursue my MBBS.
Even during my medical education, financial struggles were a constant challenge. To make ends meet, I sold dissection boxes to afford books and pay my hostel fees. These hardships taught me resilience and shaped my determination to succeed. Significantly, I built strong connections with my seniors and professors during this time, which later proved invaluable in fostering a robust network within the medical fraternity.
After earning my MBBS degree, I joined an Employees’ State Insurance Scheme of India (ESI) Hospital as a medical officer. However, I soon realised that my aspirations extended beyond the role of a practitioner—I wanted to make a broader impact. This led me to establish a family clinic in Krishna Nagar, Delhi in 1980 and then Pushpanjali Medical Centre in Anand Vihar, Delhi in 1989.
Building on this success, we went on to establish Pushpanjali Crosslay Multispecialty Hospital in Vaishali, Ghaziabad, which later became Max Super Speciality Hospital. These experiences underscored my belief in creating institutions that not only deliver excellent healthcare but also embody compassion and community service.
During your tenure as the IMA President, you led a project to improve healthcare in rural villages. Can you share some success stories from this project and the challenges you faced in implementing it?
Indeed, every new initiative comes with its share of challenges, but it is through overcoming these hurdles that meaningful change is achieved. One of the projects closest to my heart is “Aao Gaon Chalen”, which was initiated to improve healthcare access in rural areas. This initiative was introduced during the historic 191st Central Working Committee Meeting of the IMA, held from 6th to 8th June 2004 in Bangkok.
The project was formally launched on 8th August 2004 in Lakhvad, a village in Mehsana District, Gujarat. From there, it expanded significantly, with IMA state branches adopting villages across the country. Local branches identified villages based on need assessments, community requirements, and opportunities for inter-sectoral coordination, ensuring that the interventions had a wide-reaching impact.
The core goal of “Aao Gaon Chalen” was to bring about a holistic improvement in rural health by leveraging existing infrastructure and fostering partnerships among the IMA, public healthcare delivery systems, and the local community. The initiative, supported by UNICEF and some of the National Health Programmes, involved training medical professionals through ten workshops conducted in places such as Haryana, Punjab, Chennai, Ahmedabad, Trivandrum, Kanpur, Guwahati, Kolkata, Hyderabad, and Nagpur in 2004.
The results of this initiative have been transformative. Over 1,040 villages have been adopted by various IMA state and local branches to date, and the project has benefitted more than two million people. Monthly activity reports from several branches are still being compiled, but the impact of this initiative is clear. It represents a shining example of public-private partnership, aligning the efforts of the IMA with the Ministry of Health & Family Welfare to enhance rural healthcare delivery systems.
What was the goal of the project, and how was it implemented?
The overarching goal was to improve the health scenario in rural villages by promoting inter-sectoral coordination and optimising the use of existing resources. By actively involving the IMA, public healthcare systems, and community stakeholders, the project sought to foster a sustainable model of rural healthcare development.
Workshops conducted as part of the initiative trained healthcare professionals in rural health management, while the adoption of villages allowed for targeted interventions tailored to local needs. Activities included health camps, awareness campaigns, and capacity-building programmes for local healthcare providers.
Through “Aao Gaon Chalen,” the IMA demonstrated that with a concerted effort, even the most underserved communities could gain access to quality healthcare. This initiative continues to inspire similar efforts to address the healthcare needs of the country.
Is it true that during your tenure as IMA President, the “Save the Girl Child” initiative gained significant recognition?
Yes, the “Save the Girl Child” programme has been one of IMA’s flagship initiatives, and it holds a special place in my heart. This initiative, which defines “girl child” as a female up to the age of 18, is aimed at providing comprehensive support to girls, particularly from underprivileged backgrounds.
One of the key features of this programme is the provision of financial assistance. For instance, individuals can contribute by depositing a fixed amount of `1.5 lakh in a bank, with the accrued interest being credited to the girl’s account until she turns 18. Upon reaching adulthood, the donor can reclaim the principal amount.
Other aspects of the initiative include organising skill development programmes to empower girls with income-generating skills, supporting free heart surgeries for girls whose families cannot afford treatment, and adopting schools to provide health lectures and health check-ups. Additionally, the initiative addresses nutritional deficiencies by distributing iron and folic acid supplements in schools and raises awareness about child sexual abuse and the legal protections available.
The programme also encourages doctors to waive consultancy fees for the birth of a girl child and provides assistance to girls requiring critical medical treatment. Through campaigns like “950”, the initiative aims to address the gender imbalance by raising the child sex ratio to 950 girls for every 1,000 boys.
The “Save the Girl Child” initiative is more than a healthcare programme; it is a societal movement advocating for the dignity, safety, and rights of every girl child in India.
Q: Mental health is often a neglected area in Indian healthcare. How can healthcare providers and policymakers better address mental health issues across different demographics?
A: Mental health is an integral yet severely neglected aspect of healthcare in India. Globally, mental health challenges have reached alarming proportions, with over 726,000 people dying by suicide annually. This accounts for 73 per cent of global suicides predominantly occurring in low- and middle-income countries. Suicide remains the third leading cause of death among individuals aged 15–29, an age group that represents the backbone of any nation’s workforce and future. The global suicide rate among men is also more than double that of women, emphasising the need for gender-specific approaches to mental health.
In India, the situation is quite grim. The National Crime Records Bureau (NCRB) data, released in August 2022, highlighted an alarming surge in suicides. In 2021, the country recorded 164,033 suicides, marking a 7.2% increase from the previous year. This figure rose to 171,000 in subsequent years, the highest ever recorded. These staggering numbers underscore an urgent public health crisis, as most suicides stem from unresolved or untreated mental health issues.
Policymakers and healthcare providers must adopt a multi-pronged approach to combat this crisis:
1. Awareness Campaigns: Educating the public to reduce stigma surrounding mental health disorders and promote early intervention.
2. Community Outreach: Leveraging local healthcare workers and NGOs to deliver mental health education and services, especially in rural areas.
3. Workplace Policies: Encouraging mental health support systems in schools, colleges, and workplaces to address the needs of students and employees.
4. Holistic Medical Education: Reforming curricula to focus on mental health, ensuring future healthcare professionals are equipped to handle such issues compassionately.
The World Health Organization (WHO) defines mental health as more than just the absence of mental disorders. It is a state where individuals can realise their potential, cope with everyday stresses, work productively, and contribute meaningfully to their communities. Mental health must, therefore, be seen not only as the absence of illness but as an active pursuit of happiness, well-being, and balance.
Risk factors for mental health disorders are diverse and multifaceted. They include:
• Modifiable Factors: Socioeconomic conditions, employment opportunities, quality of housing, and access to education.
• Non-Modifiable Factors: Age, gender, ethnicity, and genetic predispositions.
It’s important to note that having a family history of mental illness does not guarantee the development of a disorder, just as the absence of such a history does not ensure immunity. Environmental, social, and lifestyle factors play an equally critical role in shaping mental health.
A collective effort, involving policymakers, healthcare providers, educators, and the public, is essential to ensure that mental health becomes a priority for the nation’s overall growth and well-being.
Q: Today, violence against doctors has become a crucial concern, with incidents like those at RG Kar Medical College, Kolkata. What is your take?
A: The issue of violence against doctors has reached alarming levels and has persisted for over three decades. This violence often stems from unrealistic expectations, dissatisfaction with healthcare outcomes, and frustrations related to the high cost of medical care. These challenges are exacerbated by the government’s inadequate investment in healthcare, which currently stands at 1.1% of GDP—a meagre sum compared to the total healthcare expenditure of approximately `13 lakh crore.
This financial shortfall places enormous pressure on both public and private healthcare systems. Despite their diversity, ranging from corporate tertiary care hospitals to small private clinics, instances of violence are uniformly distributed, with government hospitals frequently bearing the brunt.
In the 1980s, during my family practice, I never encountered incidents of violence. However, today’s scenario is starkly different, characterised by a significant increase in both the frequency and intensity of such incidents. This shift highlights the growing trust deficit between patients and healthcare providers.
The Supreme Court has taken steps to address this issue, and organisations like the IMA are advocating for comprehensive solutions. Key measures include:
1. Declaring Hospitals as Safe Zones: Implementing strict security protocols to ensure the safety of healthcare professionals and patients alike.
2. Enhancing Working Conditions: Providing adequate staffing, resources, and support systems to reduce stress among medical personnel.
3. Enacting Stringent Laws: Introducing legislation with severe penalties for those who commit violence against healthcare workers.
It is imperative to create an environment where doctors can work without fear, ensuring that healthcare delivery remains effective and compassionate. I, as IMA’s Action Committee Chairman, will keep on fighting for bringing a Central law against violence against medical professionals.
Q: What is your take on patient safety concerns?
A: Patient safety is a cornerstone of quality healthcare but remains a challenge due to systemic inefficiencies. It has evolved into a distinct healthcare discipline, supported by extensive research across various fields. However, its implementation often encounters resistance due to hierarchical barriers within hospitals.
For example, quality managers, who are typically junior in the hospital hierarchy, may struggle to convince senior clinicians of the importance of safety protocols. Meanwhile, administrators, focused on financial outcomes, may overlook safety concerns altogether.
To address these challenges:
1. All departments and personnel must take ownership of safety protocols.
2. Senior medical professionals must actively lead and support safety initiatives.
3. Structured discussions should take place within departments to review and refine processes.
By fostering a culture of accountability and continuous improvement, healthcare institutions can significantly enhance patient safety standards.
Q: Don’t you think there are major challenges like unfavourable outcomes and costs in healthcare?
A: Unquestionably, unfavourable outcomes and high costs are two of the most pressing challenges in modern healthcare. Public perception of the medical profession is increasingly negative, fuelled by media coverage of medical errors and incidents of violence. This has contributed to a deepening trust deficit between the public and healthcare providers.
Unfavourable outcomes, which occur when healthcare interventions do not yield the expected results, are often a result of the complexities of modern medicine. According to the Joint Commission’s Annual Report on Quality and Safety (2007), over half of serious adverse events in hospitals are caused by poor communication among healthcare providers, patients, and families. Other contributing factors include inadequate patient assessments, leadership failures, and insufficient documentation.
Addressing these issues requires a systematic overhaul of healthcare delivery processes. including:
• Improved Communication: Ensuring clarity and transparency between all stakeholders.
• Structured Training Programs: Equipping healthcare professionals with the skills needed to manage complex cases effectively.
• Robust Documentation: Maintaining comprehensive records to minimise disputes and improve patient outcomes.
Q: In the public mind, private healthcare is seen as “unreasonably” expensive. What causes this perception?
A: The cost of private healthcare appears “unreasonably” high due to the complex nature of quality healthcare delivery. Factors influencing costs include hospital type (secondary vs. tertiary), location (Tier-I, II, or III cities), and specialisation (single vs. multi-specialty). Efforts like government health insurance schemes often fix procedure costs based on the lowest tender quotes, which fail to meet the expectations of consumers and providers alike.
Transparency in cost structures and a balance between affordability and quality are essential to addressing this perception. Developing standardised models for costing can help bridge the gap between public expectations and provider capabilities.